Event RegistrationRegistration is quick and easy - simply fill out this form. Name * First Name Last Name Email * Address * Phone * (###) ### #### Childs Name * First Name Last Name Childs date of birth * MM DD YYYY What events are you Registering for? * Games Night @ WYC&CH Movie Night @ WYC&CH Tie Dye Workshop Parkour @ Dubbo PCYC Does your child have any allergies? * Yes No If you answered yes, please list here. Does your child have any medical conditions or take any regular medications? * Please list here if yes. Does Your child have any special dietary requirements? * Please list further details if yes. I agree to my child's photo being published within the organisation, and the Office of Regional Youth, newsletters, social media and for future use? * Yes No Contact in Case of an Emergency: Name, Phone Number, Relationship to child * Contact 2 in case of an Emergency: Name, Phone Number, Relationship to child * Medicare Information: Name on Card * Medicare Card Number: * Number Position on Medicare Card: * Medicare Card Expiry: * I understand that when my child is being transported to and from activities organised by the Warren Youth Group. The driver will have a valid drivers license and ensure the vehicle is appropriately registered and insured, is road worthy, and the number of passengers will not exceed the seat belt provision for the vehicle. * Agree I understand that bullying, aggression, swearing and violent behavior will not be tolerated, and your child will be sat out of activities if they are not able to follow these rules. * Agree I understand all reasonable safety precautions will be taken at all times by the organisations involved during the events and activities. All persons involved in my child's care will have current Working With Children Check. I authorize any medical treatment to my child should the need arise in the case of an emergency. I understand the possibility of hazards and risks and agree not to hold the organisations/volunteers and employees liable for damages, losses, or injuries incurred. * Agree How did you hear about us? Social Media Google Local Thank you!
